Prolonged delay in seeking medical care after the onset of acute coronary symptoms is associated with a reduced likelihood of successful coronary reperfusion and increased risk of adverse outcomes. These observations have prompted educational initiatives aimed at reducing delay time and reducing the risk of morbidity and mortality in patients with acute coronary disease. Associated with, and partially due to the improved management of patients with acute coronary syndromes, the prevalence of congestive heart failure (HF) in the U.S. has increased dramatically over time. Despite the fact that this clinical syndrome is characterized by acute exacerbations, surprisingly little investigative work has examined extent of delay in seeking medical care after the onset of HF related symptoms and the impact of prolonged delay on subsequent management practices and outcomes. The objectives of the proposed observational study are to prospectively evaluate extent of delay from symptom onset until hospital presentation in patients with acute HF, examine factors associated with prolonged delay, and the relation of delay times to specific hospital and post-discharge outcomes. The study will be carried out in adult male and female patients of all ages presenting with HF to 3 urban Worcester (MA) hospitals. The study objectives will be accomplished through individual patient interviews as well as through the review of medical records. A standardized survey, designed to quantify and characterize delay patterns associated with the onset of acute HF, will be administered to consenting patients. Where possible, patients'spouses will also be interviewed. We anticipate enrolling 1750 to 2100 patients with validated acute HF over a 3.5-year period. To the best of our knowledge, although data describing the magnitude of, and factors associated with, pre-hospital delay have been collected in patients with acute myocardial infarction, comparable information does not exist for patients with acute HF. If an association between prolonged delay times and increased risk of adverse outcomes can be demonstrated and characterized for patients with acute HF, this may justify broader educational initiatives aimed at the general public and their health care providers to decrease the time interval between symptom onset and seeking of medical care. Relevance: Heart failure is currently recognized as a major public health problem. This study will examine factors associated with delay in seeking medical care in patients with heart failure and the impact of delay on morbidity and mortality. These data will be useful in the development of future educational and treatment strategies designed to improve outcomes in patients with heart failure.